Fiber tip fluid output device

ABSTRACT

A fiber tip fluid output device is provided for holding a fiber tip in an electromagnetic energy cutting apparatus and for directing water particles over a radiation delivery end of the fiber tip. The fiber tip fluid output device includes a generally cylindrical body having an outer surface, a proximal end, a distal end, and a lumen extending between the proximal end and the distal end. The lumen is sized and shaped to accommodate a fiber tip therethrough so that the fiber tip extends through the lumen from the proximal end to the distal end of the generally cylindrical body. The fiber tip fluid output device further includes a plurality of apertures extending around the generally cylindrical body, with each of the apertures of the plurality of apertures fluidly connecting the outer surface to the lumen. Fluid is mixed around the cylindrical body, before entering the lumen through the plurality of apertures for additional mixing. The mixed fluid is then output from the lumen of the fiber tip fluid output device onto the fiber tip, for subsequent interaction with electromagnetic energy in an interaction zone above a target surface.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.11/644,155, filed Dec. 22, 2006, now U.S. Pat. No. 7,424,199, which is acontinuation of U.S. application Ser. No. 10/404,683, filed Apr. 1,2003, now U.S. Pat. No. 7,187,822, which is a continuation of U.S.application Ser. No. 09/822,981, filed Mar. 30, 2001, now U.S. Pat. No.6,567,582, both of which are commonly assigned and the contents of whichare expressly incorporated herein by reference. This application is alsoa continuation-in-part of U.S. application Ser. No. 09/469,571, filedDec. 22, 1999, now U.S. Pat. No. 6,389,193, which is commonly assignedand the contents of which are expressly incorporated herein byreference. This application is a also a continuation-in-part of U.S.application Ser. No. 09/256,697, filed Feb. 24, 1999, now U.S. Pat. No.6,350,123, which is commonly assigned and the contents of which areexpressly incorporated herein by reference. U.S. application Ser. No.09/256,697 is a continuation-in-part of U.S. application Ser. No.08/985,513, filed Dec. 5, 1997, now abandoned, which is a continuationof U.S. application Ser. No. 08/522,503, filed Aug. 31, 1995, (now U.S.Pat. No. 5,741,247), and is a continuation-in-part of U.S. applicationSer. No. 08/995,241, filed Dec. 17, 1997, now abandoned, which is acontinuation of U.S. application Ser. No. 8/575,775, filed Dec. 20,1995, (now U.S. Pat. No. 5,785,521), the contents of which are expresslyincorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to handpieces for deliveringelectromagnetic radiation.

2. Description of the Related Art

Handpieces have existed in the prior art for delivering electromagneticradiation.

SUMMARY OF THE INVENTION

The rotating handpiece of the present invention includes a fiber tipfluid output device and a removable trunk fiber optic. The trunk fiberoptic and the fiber tip are disposed perpendicularly, with a parabolicmirror disposed there between. Slight misalignments of the trunk fiberoptics, as well as imperfections on the output surface of the fiberoptic, are compensated by the parabolic mirror which consistently andefficiently focuses the electromagnetic energy into the input end of thefiber tip. Moreover, in accordance with one aspect of the presentinvention, the handpiece can be rotated about the longitudinal axis ofthe trunk fiber optic, with the parabolic mirror continuing toefficiently couple the electromagnetic energy from the trunk fiber opticinto the fiber tip.

In accordance with one aspect of the present invention, a fiber tipfluid output device is provided for holding a fiber tip in anelectromagnetic energy cutting apparatus and for directing waterparticles over a radiation delivery end of the fiber tip. The fiber tipfluid output device comprises a generally cylindrical body having anouter surface, a proximal end, a distal end, and a lumen extendingbetween the proximal end and the distal end, the lumen being sized andshaped to accommodate a fiber tip therethrough so that the fiber tipextends through the lumen from the proximal end to the distal end of thegenerally cylindrical body. The fiber tip fluid output device furthercomprises a plurality of apertures extending around the generallycylindrical body, wherein each of the apertures of the plurality ofapertures fluidly connects the outer surface to the lumen. Fluid ismixed around the cylindrical body, before entering the lumen through theplurality of apertures for additional mixing. The mixed fluid is thenoutput from the lumen of the fiber tip fluid output device onto thefiber tip, for subsequent interaction with electromagnetic energy in aninteraction zone above a target surface.

The present invention, together with additional features and advantagesthereof, may best be understood by reference to the followingdescription taken in connection with the accompanying illustrativedrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a cross sectional view of the rotating handpiece in accordancewith the presently preferred embodiment;

FIG. 2 is a cross sectional view of an alternative embodiment of therotating handpiece;

FIG. 3 is a side elevation view of the rotating band piece in apartially disassembled state;

FIG. 3 a depicts a chuck according to a feature of the presentinvention;

FIGS. 4 a-4 c, 5 a-5 c, 6 a and 6 b are other views of the invention;

FIG. 7 is a perspective view of the loading tool, fiber tip fluid outputdevice, and handpiece head in a disassembled configuration;

FIG. 8 is an end view of the loading tool, taken along the line 8-8 ofFIG. 7; and

FIG. 9 is a perspective view of the fiber tip fluid output devicepartially secured onto the loading tool, just before insertion of thefiber tip fluid output device into the handpiece head.

DETAILED DESCRIPTION OF THE PRESENTLY PREFERRED EMBODIMENTS

Referring more particularly to the drawings, FIG. 1 illustrates a crosssectional view of the rotating handpiece 10. The rotating handpiececomprises a handpiece head 12, a fiber tip fluid output device 14, and aremovable trunk fiber assembly 16. These components can be seen in apartially disassembled state in FIG. 3, wherein the axis 18 of theremovable trunk fiber assembly 16 is aligned with the axis 20 of thehandpiece head 12 for insertion into the handpiece head 12. Once theaxis 18 of the removable fiber assembly 16 is aligned with the axis 20of the handpiece 12, the removable trunk fiber assembly 16 is moved inthe direction of the arrow A1 into the handpiece head 12, while the axis18 and 20 are maintained in approximate alignment. The contactingsurface of the outer surface of the chuck 23 engages the inner surface25 of the rotating handpiece 10, to thereby ensure alignment of the axis18 of the removable trunk fiber assembly 16 and the axis 20 of thehandpiece head 12. As the removable trunk fiber assembly 16 is insertedfurther in the direction A1 into the handpiece 12, the abutting surface28 engages with a corresponding abutting surface (not shown) within thecollar 31 of the handpiece head 12. The corresponding abutting surface28 preferably snaps with the abutting surface 31, as the removable trunkfiber assembly 16 is fully inserted into the handpiece head 12. Any typeof locking engagement between the abutting surface 28 and acorresponding abutting surface within the collar 31, as known in theart, may be used to ensure that the removable trunk fiber assembly 16 isalways inserted the same distance into the handpiece head 12. As shownin FIG. 1, the distal tip 38 of the removable trunk fiber assembly 16 isbrought into close proximity with the parabolic mirror 41. In thepresently preferred embodiment, the distal tip 38 of the removable trunkfiber assembly 16 comprises a window 43 for protecting the trunk fiberoptic 45 from contaminants, such as water. In the alternative embodimentshown in FIG. 2, the distal tip 38 a is not protected with a window. Asshown in FIG. 1, the fiber tip 51 of the fiber tip fluid output device14 is also accurately placed in close proximity to the parabolic mirror41. Fiber tips are known in the art for use as waveguides. Theabove-referenced U.S. Pat. No. 5,741,247 discloses implementation ofguides and waveguides in the context of a fiber tip. A loading tool 17is preferably used to assist in the placement of the fiber tip fluidoutput device 14 into the handpiece head 12, as discussed below withreference to FIGS. 5 and 7-9. Electromagnetic energy exiting from theoutput end 55 of the trunk fiber optic 45 is collected by the parabolicmirror 41 and, subsequently, reflected and focused onto the input end 59of the fiber tip 51.

In the presently preferred embodiment, the electromagnetic energyexiting from the output end 55 of the trunk fiber optic 45 comprises awavelength on the order of 3 mm. The material of the parabolic mirror 41is selected to provide an efficient reflection and focusing into theinput end 59. As presently embodied, the electromagnetic energy isgenerated from an Er:YSGG laser, and the material of the parabolicmirror 41 comprises a gold plating to provide reflectivity ofapproximately 99.9 percent. Other materials may be selected inaccordance with design parameters. Other reflective surfaces andmaterials for the parabolic mirror 41 may be selected, in accordancewith the laser being used and the desired efficiency of reflection. Forexample, if a lower reflectivity is selected, then additional coolingmay be needed for the parabolic mirror 41 (such as a greater flow rateof cooled and/or filtered air across the surface of the parabolic mirror41). FIGS. 4 a, 4 b and 4 c illustrate various views of the parabolicmirrors 41 of the presently preferred embodiment. The flat surface ofthe parabolic mirror 41, which is closest to the fiber tip 51, ispreferably provided with two recessed areas 66 and 69. These tworecessed areas mate with corresponding protrusions (not shown) on thefloor 71 of the internal chamber 73 of the handpiece head 12. A springloaded plunger 76 presses against the upper surface 79 of the parabolicmirror 41 under the pressure of the spring 81. A screw cap 83 holds thespring 81 against the spring loaded plunger 76. The combination of thespring loaded plunger 76, the recessed areas 66,69 of the parabolicmirror 41, and the corresponding protrusions on the floor 71, together,accurately align the parabolic mirror 41 for efficient coupling ofelectromagnetic energy between the output end 55 of the trunk fiberoptic 45 and the input end 59 of the fiber tip 51. In modifiedembodiments, either or both of the output end 55 of the trunk fiberoptic 45 and the input end 59 of the fiber tip 51 is/are provided withan anti-reflective coating. Although it is preferred to have the trunkfiber optic 45 perfectly aligned in relation to the parabolic 41 and thefiber tip 51, the alignment between these three elements is seldomlvperfect. In the presently preferred embodiment, the misalignment of theaxis of the trunk fiber optic 45 and the axis of the fiber tip 51 iswithin plus or minus 1 percent error.

In a modified embodiment, a pentaprism (five-sided prism) is usedinstead of the parabolic mirror 41 for coupling the trunk fiber optic 45to the fiber tip 51.

In addition to slight misalignment of the axis of the trunk fiber optic45, slight imperfections on the output end 55 of the trunk fiber optic45 may also be present. The parabolic mirror 41 corrects for both ofthese slight errors, by collecting the electromagnetic energy from theoutput end 55 of the front fiber optic 45 and, subsequently, focusingthe electromagnetic energy to the output end of the rotating handpiece10 at which location the input end 55 of the fiber tip 51 receives thefocused electromagnetic energy. If the output end of the fiber tip 51 isconsidered to be the output end of the rotating handpiece 10, thenenergy exiting the output end of the fiber tip 51 will, by definition,exit the output end of the rotating handpiece 10 at the same time.

The parabolic mirror 41 may also comprise molypdium, in a preferredembodiment.

The clamp assembly 91 operates to firmly grip and hold the trunk fiberoptic 45. In the presently preferred embodiment, the clamp assembly 91is provided with at least one slit, which extends from the distal end 93of the clamp assembly 91 to a region 95 just distal of the set screw 97.As presently embodied, the at least one slit extending from the distalend 93 to the region 95 just distal of the set screw 97 comprises twoslits, which are adapted to allow the clamp assembly 91 to be compressedby the chuck 23 onto the trunk fiber optic 45. The chuck 23 thus pressesagainst the portion of the clamp assembly 91, wherein the portion isdefined between the distal end 93 and the region 95, to thereby have theclamp assembly 91 squeeze and hold the trunk fiber optic 45 in place. Inthe presently preferred embodiment, the set screw 97 is used to hold thechuck 23 in place and prevent rotation thereof. In the illustratedembodiment, the outer surface of the clamp assembly 91 is provided withthreads 99 for engaging with corresponding threads on the inner surfaceof the chuck 23. In the presently preferred embodiment, the chuck 23 isscrewed onto the threads of the clamp assembly 91, before the removabletrunk fiber assembly 16 is inserted into the handpiece 12. The chuck 23is screwed onto the clamp assembly 91 to a predetermined tightness, andthen the set screw 97 is secured thereto to securely hold the chuck 23to the clamp assembly 91. Subsequently, the removable trunk fiberassembly 16 is inserted and secured into the handpiece head 12.

Referring to FIGS. 5 and 7-9, the fiber tip fluid output device 14comprises a generally cylindrical body having an outer surface, aproximal end, a distal end, and a lumen extending between the proximalend and the distal end. The lumen is sized and shaped to accommodate thefiber tip 51 a therethrough so that the fiber tip 51 a extends throughthe lumen from the proximal end to the distal end of the generallycylindrical body. The fiber tip fluid output device 14 further comprisesa plurality of apertures 125 extending around the generally cylindricalbody. Each of the apertures 125 fluidly connects the outer surface tothe lumen. As presently embodied, the lumen comprises a first diameternear the proximal end and a second diameter near the distal end, whereinin the illustrated embodiment the second diameter is greater than orequal to about two times the first diameter. As presently embodied, thelumen comprises a proximal lumen section and a distal lumen section, theproximal lumen section having a diameter which in the illustratedembodiment is equal to the first diameter and the distal lumen sectionhaving a diameter which in the illustrated embodiment is equal to thesecond diameter. The proximal lumen section comprises a proximal end, adistal end, and a lumen axis extending between the proximal end and thedistal end; the distal lumen section comprises a proximal end, a distalend, and a lumen axis extending between the proximal end and the distalend; and the diameter of the proximal lumen section in the illustratedembodiment is preferably substantially constant along a length of theproximal lumen section between the proximal end of the proximal lumensection and the distal end of the proximal lumen section. The diameterof the distal lumen section is preferably substantially constant along alength of the distal lumen section between the proximal end of thedistal lumen section and the distal end of the distal lumen section. Inthe illustrated embodiment, the first diameter transitions to the seconddiameter at the distal end of the proximal lumen section and theproximal end of the distal lumen section, a distal opening of the fibertip fluid output device 14 has a diameter which is equal to the seconddiameter, and a proximal opening of the fiber tip fluid output device 14has a diameter which is equal to the first diameter. In the illustratedembodiment, each of the apertures 125 has a diameter which is about halfof the first diameter.

The apertures 125 are preferably disposed within a first depression 121(FIG. 5 a). Consistent with the definition of a depression (e.g., asurface depressed relative to, or elevationally lower than, adjacentsurfaces), surfaces on opposing sides of the depression 121 are elevatedrelative to the elevation of the first depression 121. A seconddepression extends around the generally cylindrical body near theproximal end, and a third depression extends around the generallycylindrical body near the distal end, wherein the first depression isdisposed about half way between the second depression and the thirddepression in the illustrated embodiment. As presently embodied, thedistal lumen section tapers into the proximal lumen section along alength of the lumen that in the illustrated embodiment is equal to aboutone third of at least one of the cross-sectional diameters of theapertures 125.

The rotating handpiece 10 of the presently preferred embodimentpreferably uses the electromagnetically induced cutting system disclosedin U.S. Pat. No. 5,741,247, the entire contents of which are expresslyincorporated herein by reference. For example, an engineered andcontrollable atomized distribution of fluid particles is placed into aninteraction for absorption of electromagnetic energy (from the fiber tip51 a) and for subsequent expansion to impart mechanical cutting forcesonto a target surface. In the illustrated embodiment of FIG. 1, separateair and fluid lines 111, 113, which may be similar to those described inU.S. Pat. No. 5,741,247, run parallel to one another in the distaldirection toward the feed channels 115, 117. In other embodiments, theair and fluid lines 111, 113 may comprise a first fluid line forcarrying a first fluid and a second fluid line for carrying a secondfluid, and further may comprise one or more additional fluid lines (notshown). Thus, while the illustrated embodiment describes the first fluidbeing air and the second fluid being water, the present disclosure isnot limited to such structure and use. For example, the first and secondfluids, and additional fluids, may comprise any of the componentsdescribed in U.S. Pat. No. 5,785,521, the entire contents of which areexpressly incorporated herein by reference. Some or all of thecomponents of U.S. Pat. No. 5,785,521 may be premixed and carriedthrough fluid lines, such as the lines 115, 117, or not premixed andmixed within the circumferential chamber 119 discussed below. The feedchannels 115, 117, carrying a supply of air and water, respectively, aspresently embodied, feed into circumferential chamber 119. Referring toFIGS. 5 a-5 c, the circumferential chamber 119 is preferably formed in afirst depression 121 of the fiber tip ferrule 123. In an alternativeembodiment, the section 121 may not have any depression.

As can be seen from FIG. 5 b, for example, four apertures 125 aredisposed in the first depression 121 of the fiber tip ferrule 123. Inmodified embodiments, other numbers of apertures may be incorporated.Air traveling into the circumferential chamber 119 from the feed channel115, and water traveling into the circumferential chamber 119 from thefeed channel 117, are both initially mixed in the circumferentialchamber 119. In one embodiment, the first and second fluids may compriseair and a medicated or flavored water, and in another embodiment thefirst and second fluids may comprise water and at least one other fluid.In still another embodiment, at least one of the first and second fluidsmay comprise a medicament, such as chlorhexidine gluconate.

The initially-mixed air and water travel from the circumferentialchamber 119 through the orifices 125 and into the lumen 133. The air andwater is further mixed and atomized within the lumen 133. The atomizedwater under air pressure subsequently travels along the fiber tip 51 ina direction toward the output end 136 of the fiber tip 51. In apreferred embodiment, the fiber tip 51 a is permanently affixed to andextends through the fiber tip fluid output device 14. As presentlyembodied, three O-ring seals 139 are provided to seal the inside of therotating handpiece from the air and water.

FIG. 7 illustrates the loading tool 17, the fiber tip fluid outputdevice 14, and handpiece head 12 in a disassembled configuration, andFIG. 8 is an end view of the loading tool 17, taken along the line 8-8of FIG. 7.

FIG. 9 shows the fiber tip fluid output device 14 partially secured ontothe loading tool 17. The proximal end of fiber tip fluid output device14 is preferably gripped by the hand of a user and slid into the slot 19of the loading tool 17 in the direction of the arrow A2. As presentlyembodied slot 19 fits around the third depression 21 of the fiber tipfluid output device 14, and the fiber tip fluid output device 14 is slidwithin the slot 19 in the direction of the arrow A2 until the fiber tipfluid output device 14 reaches the end 24 of the slot 19. The loadingtool is then advanced in the direction of the arrow A3 to firmly securethe fiber tip fluid output device 14 into the orifice 26 of thehandpiece head 12. The loading tool 17 is then removed from the fibertip fluid output device 14 to leave the fiber tip fluid output device 14firmly secured within the orifice 26. As presently embodied, a width ofthe slot 19 is slightly larger than a diameter of the third depression21, so that the fiber tip fluid output device 21 can be removably andsnugly held by the loading tool 17.

Referring to FIG. 3, the removable trunk fiber assembly 16 is preferablyprovided with three radial ports for introducing air, water, and(optionally) cooling air. More particularly, a fluid radial channel 161feeds fluid (e.g., water) into the fluid channel 111, an air radialchannel 163 feeds air into the air channel 113, and an optionalcooling-air radial channel 165 feeds cooling air along a cooling-airchannel, which exits in close proximity to the parabolic mirror 41. In apreferred embodiment, the exit angle of the cooling air channel directscooling air directly onto the parabolic mirror 41, so that the coolingair is reflected from the parabolic mirror 41 onto the input end 59 ofthe fiber tip 51 and, subsequently, onto the window 43. In FIG. 2, thecooling air exits from an orifice 181 a and is channeled directly ontothe input end 59 a of the fiber tip 51 a. Subsequently, the air isdirected onto the parabolic mirror 41 and reflected onto the output end55 of the trunk fiber optic 45. This configuration could also beimplemented for the system of FIG. 1, wherein the cooling airsubsequently is directed onto the window 43. Alternatively, in theembodiment of FIG. 2, the cooling air exiting the orifice 181 a can bechanneled directly onto the parabolic mirror 41, focusing onto the inputend 59 a of the fiber tip 51. In the embodiments of both FIG. 1 and FIG.2, the cooling air is subsequently channeled in the direction of thearrows A2 through channels formed in the chuck 23. As shown in FIG. 3 a,the chuck 23 preferably has portions of its two sides removed, tothereby form channels for passage of the cooling air. The cooling airtravels through the channels of the chuck 23 under a vacuum pressureand, subsequently, is drawn into a removal port 191. Upon entering theremoval port 191 under the vacuum, the cooling air travels in adirection opposite to the arrow A1 and exits the removal trunk fiberassembly 16. The four O-rings 196 insulate the radial channels 161, 163,165 from one another.

FIG. 6 a illustrates a side elevation view of the assembled rotatinghandpiece 10 and FIG. 6 b illustrates a modified embodiment of therotating handpiece 10, wherein the neck is slightly bent. In FIG. 6 athe portion indicated by reference numeral 203 is adapted to rotateabout an axis of the rotating handpiece 10. The portion 205 does notrotate. Similarly, in FIG. 6 b, the portion 207 is adapted to rotateabout an axis of the rotating handpiece, and the portion 209 docs notrotate. In the embodiment of FIG. 6 b, the trunk fiber optic isconfigured to be slightly flexible, since the trunk fiber optic willneed to bend and flex as the portion 207 is rotated relative to theportion 209. In either of the embodiments of FIGS. 6 a and 6 b, the userholds the rotating portion (203 or 207) with his or her thumb and twofingers (such as is conventional in the art) and allows the stationaryportion (205 or 209) to rest on a portion of the hand bridging theuser's forefinger and thumb. The three fingers holding the rotatingportion (203 or 207) contact the rotating portion and can rotate therotating portion, as the fixed portion (205 or 209) does not rotate andrests on the portion of the hand bridging the hand and the forefinger.Although an exemplary embodiment of the invention has been shown anddescribed, many other changes, modifications and substitutions, inaddition to those set forth in the above paragraphs, may be made by onehaving ordinary skill in the art without necessarily departing from thespirit and scope of this invention.

1. A device for holding a waveguide in a vicinity of an apparatus andfor directing fluid over an energy delivery end of the waveguide, thedevice comprising: a body having an outer surface, a proximal end, adistal end, and a lumen disposed at one or more points between theproximal end and the distal end, the lumen being sized and shaped toaccommodate a waveguide so that the waveguide extends within a vicinityof the lumen; a depression extending around the outer surface of thebody and serving as a mixing chamber for mixing fluids together when thedevice is connected to the apparatus, whereby at least two opposingregions adjacent to the depression are elevated relative to thedepression; and a plurality of apertures extending around the body andfluidly connecting the outer surface to the lumen.
 2. The device as setforth in claim 1, wherein the waveguide is a fiber tip.
 3. The device asset forth in claim 1, wherein the fluid is water and the waveguidecomprises an electromagnetic energy source having one of a wavelengthwithin a range from about 2.69 to about 2.80 microns and a wavelength ofabout 2.94 microns.
 4. The device as set forth in claim 1, wherein thewaveguide comprises one of an Er:YAG, an Er:YSGG, an Er, Cr:YSGG and aCTE:YAG laser.
 5. The device as set forth in claim 1, wherein the fluidcomprise water particles.
 6. The device as set forth in claim 1,wherein: the directed fluid comprises atomized fluid particles that aredirected into a volume above a target surface; and the waveguide isconfigured to impart relatively large amounts of energy into theatomized fluid particles in the volume above the target surface tothereby expand the atomized fluid particles and impart the disruptiveforces onto the target surface.
 7. The device as set forth in claim 1,wherein the target surface comprises one of tooth, bone, cartilage andsoft tissue.
 8. A fiber tip fluid output device for holding a fiber tipin an electromagnetic energy cutting apparatus and for directing fluidparticles over a radiation delivery end of the fiber tip, the fiber tipfluid output device comprising: a generally cylindrical body having anouter surface, a proximal end, a distal end, and a lumen extendingbetween the proximal end and the distal end, the lumen being sized andshaped to accommodate a fiber tip therethrough so that the fiber tipextends through the lumen from the proximal end to the distal end of thegenerally cylindrical body, whereby energy exiting the radiationdelivery end at the same time exits the electromagnetic energy cuttingapparatus; and a plurality of apertures and a depression extendingaround the generally cylindrical body as a mixing chamber for mixingfluids when the device is connected to the a apparatus, each of theapertures of the plurality of apertures fluidly connecting the outersurface to the lumen.
 9. The fiber tip fluid output device as set forthin claim 8, wherein the fluid is water and the electromagnetic energycutting apparatus comprises one of an Er:YAG, an Er:YSGG, an Er, Cr:YSGGand a CTE:YAG laser.
 10. The fiber tip fluid output device as set forthin claim 8, wherein: the directed fluid particles atomized fluidparticles that are directed into a volume above a target surface; andthe electromagnetic energy cutting apparatus is configured to impartrelatively large amounts of energy into the atomized fluid particles inthe volume above the target surface to thereby expand the atomized fluidparticles and impart the disruptive forces onto the target surface. 11.The fiber tip fluid output device as set forth in claim 8, wherein thetarget surface comprises one of tooth, bone, cartilage and soft tissue.12. The device as set forth in claim 1, wherein the energy delivery endis disposed to perform one or more of (a) emitting energy from a pointdistally beyond both the distal end and the device, and (b) directingenergy outside of and distally away from the apparatus.
 13. The deviceas set forth in claim 12, wherein the waveguide comprises anelectromagnetic energy source having one of a wavelength within a rangefrom about 2.69 to about 2.80 microns and a wavelength of about 2.94microns.
 14. The device as set forth in claim 12, wherein the waveguidecomprises one of an Er:YAG, an Er:YSGG, an Er, Cr:YSGG and a CTE:YAGlaser.
 15. The device as set forth in claim 12, wherein the fluidcomprise water particles.
 16. The device as set forth in claim 12,wherein: the directed fluid comprises atomized fluid particles that aredirected into a volume above a target surface; and the waveguide isconfigured to impart relatively large amounts of energy into theatomized fluid particles in the volume above the target surface tothereby expand the atomized fluid particles and impart the disruptiveforces onto the target surface.
 17. The device as set forth in claim 12,wherein the apertures extend around the body.
 18. The device as setforth in claim 12, wherein the waveguide is a fiber tip and the fluid iswater.